RESULTS
7.7 BEHAVIOURAL PRACTICES .1 Sexual Activity and Frequency
Current behavioural practices are extremely crucial in considering ways to promote HIV prevention practices. The practice and frequency of sexual intercourse, and condom usage among sexually active respondents were investigated.
7.7.1.1 Sexual Activity - Only 14 % of respondents reported being sexually active or
having had sexual intercourse. This finding is not in keeping with other surveys (Buga et al, 1996 and National Youth Survey, 2000), where an increasing number of young South Africans were found to be sexually active (60% and 30% respectively). Although the findings from the present study show that a significant minority of MMR adolescents are sexually active as compared to non retarded adolescents, the data is consistent with reports documenting that persons with mental retardation can be sexually active (e.g.
Timmers et al, 1981). It was interesting that an item analysis did not reveal gender differences in being sexually active. This finding is in contradiction to studies (Buga et al,
1996) where more males than females were found to be sexually experienced by the time they were 15 to 16 years of age. Personal exposure to infected persons produced significant main effects on sexual activity, where respondents with high levels of personal exposure reported not being sexually active. The choice of abstaining from sex could be related to fear of contracting a disease that is generally perceived to be sexually transmitted.
Several respondents appeared to be embarrassed and anxious when asked whether they were sexually active, probably because they have learned that it is not proper to talk about sex. Additionally, interviewer effects could also have confounded the results.
Therefore, it is reasonable to assume that the results may not be a true reflection of the number of sexually active respondents, with a larger number of respondents than reported being sexually active.
The question "Have you ever had sex?" was intended to capture trends, which occur within relationships, and not to evoke issues regarding "forced sex". However, two of the respondents reported that their first sexual experience was as a result of sexual abuse by a parent1. As is being more commonly acknowledged (e.g. Sobsey et al, 1995), sexual abuse is a potential threat to this population and it represents an additional source of risk risk for HIV infection. The data from this study is therefore consistent with other studies documenting that persons with mental retardation can be sexually active and experience sexual abuse.
7.7.1.2 Number of Sexual Partners in the last 6 months - The risk factor of having
multiple sex partners was considered by inquiring about the number of sexual partners respondents had had in the last 6 months. Of these, 69% reported having one sexual partner, 15.5% reported having 2 partners and 15.5% reported having more than 3
partners. Unfortunately the data obtained does not indicate the age of first sexual intercourse and for future research it would be advisable to include questions relating to this. Statistical analysis revealed no significant age and grade differences in the number of sexual partners in the last 6 months.
In the present study the large majority of respondents reported having one sexual partner.
This could be explained in terms of their sexual activity being of recent onset. The
1 On probing, both respondents reported that they had brought the issue of their abuse to the attention of the relevant authorities (teacher/principal) and both had received social work intervention and counselling. This was corroborated by the principal of the school. In addition, the researcher offered both the respondents as well as the principal her services with regard to any supportive counselling that might be required, under
respondents who reported having more than 1 sexual partner could have had an earlier sexual onset, as a result of which they are inclined to have more sexual partners. A further explanation for adolescents having multiple sexual partners could be due to the adolescent stage being characterized by sexual experimentation with different persons (Erikson, 1963).
Statistical analysis showed that respondents with high levels of personal exposure to HIV/AIDS reported having fewer sexual partners in the last 6 months. The results of this study thus has important implications for developmental prevention programmes, where exposure of adolescents to infected persons could be used as one means of encouraging a reduction in the number of sexual partners.
7.7.2 Condom Usage
7.7.2.1 Carrying a Condom - The availability of a condom to respondents was explored.
All respondents, irrespective of whether or not they were sexually active, were asked whether they carried condoms with them. It was worrying to note that only 1% of respondents indicated that they always carry condoms, 2% indicated sometimes and 97 % reported never carrying a condom with them. The findings of this study are similar to the NPPHCN (1995) study, where it was found that although a large majority of students in the study knew that condoms prevent AIDS transmission, they did not carry condoms.
This demonstrates that knowledge about health risks and preventative health behaviours is not in itself sufficient to produce changes in risk behaviour.
The nature of the study did not permit inquiry into the reasons as to why most respondents did not carry condoms with them. However, this seems to be a crucial issue which should be explored in future research. A possible reason as to why the large majority of respondents reported not carrying a condom could be because many respondents are not sexually active and therefore do not see the need to carry a condom.
Other reasons could be lack of availability, as well as running the risk of embarrassment and being accused of immorality in the event of being found with a condom, especially within the school context.
7.7.2.2 Regularity of Condom Use by Sexually Active Respondents - The use of a condom by sexually active respondents was explored. The regularity of condom use amongst sexually active respondents was disappointingly low, with only 46% indicating regular condom use. This finding is consistent with that of Abdool Karim, Soldan and Zondi (1995), who found that among adolescents in KwaZulu Natal, sexual relations were typified by a lack of condom use. Reasons for low condom use were not elicited. Given that individual behaviour depends on various personal and environmental conditions, the reasons for irregular condom use may not lie in the lack of knowledge or negative attitudes towards condoms but also in the lack of availability of condoms or lack of skills in how to use condoms. A significant relationship was found between knowledge of condom use and regularity of condom use suggesting that an increase in knowledge levels can lead to preventative action. Further, it is instructive to note that a significant positive association was returned in this study between knowledge of condom use and threat appraisal with higher levels of appreciation of personal susceptibility and severity
to HIV/AIDS predicting better knowledge of condom use. The obvious implication for the design of prevention programmes is to target both threat appraisal and knowledge and skills in condom use as means of increasing the likelihood of protective sexual behaviour.